HomeMy Public PortalAbout5703 RIO HONDO AVE_Electrical__ !A663-CES06 5-62 APPLICATION FOR EL CTR AL PERM
COUNTY OP LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER 9
WILLIAM A.JENSEN,'SUP`T OF BUILDING LOCALITY ` 'C
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
RECEPT. TOTAL NO. EACH FEE
r OUTLETS FIRST 20 111 $ OWNER r
LIGHT ADO'L .1C ADDRESS +�
SWITCH. OVER 20
LIGHTING 1t TOTAL FIRST 20 .20 CITY ✓s [TEL. O.
FIXTURES 1 AOD'L10 ELECTRICIAN CP
)))
OVER 20 �y�y
NGEB 69
CLO.DRYERS WTR.HTRS. 1.00 V ri ADDRESS -
GARB.DISP. STA.COOK CITY TEL.NO. xU
DISHWASH. AUTO.-WASH. STATE +7 le",
SPACE HTRS. STA.APP..(Vy H.P.MAX.) .50 LICENSE NO. i 8 -
MOTORSe OVER NOT OVER H.P. DISTRICT NO. GROUP I ZONE PXQCESSED BY
O 1 1.00 JdFl
to
1 s 1.50 INSPECTION RECORD
a a 2.00
a 15 2.50 O
is so 3.00 U
- m
50 100 5.00 type
SIGNSe NO.TRANS. _ v
NO.LAMPS. - a
U)
SERVICE O.600V-NOT OVER 200A 1.00
SERVICE O.SOOV.OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE__ .- __2.00. Q
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE INBPECTOR'B SIGNATURE
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT ► .� N.-..
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING Jls�
ELECTRICAL WIRING. - WIRINGAI C"'Ll
I HEREBY CERTIFY TH 1 A PROP RLY REGISTERED AND/OR
LICENSED'AS REQUIRED LO ANG 8 NTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I jAM E L AL NE F-1`HE ABOVE
DESCRIBED RESIDENT L RO - POWER ...�-
SIGNATURE ' UTILITY CO.NOTIFIED'
OF PERMITTEE
FINAL
-MALIDATION ARTHUR.C. VEIT` I' - rtr
CK
NO CASH SUPERVISING ELECTRICAL ENGINEER
T. 9 4 :i 6 G MAR 9 2 D 5.00-
. .WORKERS'COMPENSATION DECLARATION 76-863 10/91 APPLICATION FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of of cons consent to self,Insure, CE-8060
ora certificate of Workers' Compensation Insurance, 6r'a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800,Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
c
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE ADDRESS AVVY ` O
LOCALITY /J
Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ `� ��
department. Multi-family Sq.Ft.
NEAREST
CROSS ST.
DAk
Date Applicant Residential Swimming Pools OWNER OR v
FIRM NAME �{
CERTIFICATE OF EXEMPTION FROM WORKERS' L MAIL
Outlets:Rec Light_Sw.—
COMPENSATION INSURANCE ADDRESS /y
(This section need not be completed If the work involved by the First 20
permit is for one hundred dollars($100)or less.)
Total No. AdditionalPLAN CHEC
CITY `�� Tel.No.
I certify that in the performance of the work for which this permit APPLICANT K
elf
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Total No.
Date Additional CITY Tel.No.Applicant Fixed Appliances Not Over 1 HP PERMIT
it
NOTICE ICANT: If, after making this Certificatq of 1�`
Exemption,yALyou should become subject to the Workers'Compens on Range_ Heater D.W. _ APPLICANT �v f'C
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ / ADDRESS J!;?
provisions or this permit shall bo deemed revoked. Top — FAU W.H. _
���/�.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_ CITY Tel.No. S'
I hereby affirm that I am licensed under provisions of Chapter 9Disp. — Room Air Cond. LICENSE OR L"9 Class. ��
(commencing with Section 7000)of Division 3 of the Business and REG NUMBER F�
Professions Code,and my license is in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. PRC ED BY
lr-
Lic.Class ,(� Size&Type HP,KW, a.
KVB,/'BAR / FINAL • a� V
License Number /! U to 1 I cl.
r �j r� Over 1 to 10 Incl. DATE +, n� T
Contractor Date .3 Over 10 to 50 Incl. t
❑ FINAL
I am exempt under Sec. Over 50 to 100 Inc. BY
B.&P.C.for this reason Over 100 N
Date:
Services,Swbd.,MCC&Panelboards ® QOIIO_ 0 10/ 2•}'`y
0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
Over 1000 Amp.or Over 600 V 215721 A110%26
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit
I hereby affirm that I am exempt from the Contractor's License Law Additional Sign Branch Circuits
for the following reason(Section 70315,Business and Professions
Code):
Misc.Conduits&Conductors
I,as owner of the property,will do the work and the structure Other(See Complete Fee Schedule)
is not intended or offered for sale (Section 7044, Business
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued(Sec.3097,
PERMIT FEE (Sub Total) �' o
Civ.C.).
PLAN CHECKING FEE
Lender's Name
PERMIT ISSUING FEE
Lender's Address / 0
I certify that I have read this application and state that the above TOTAL FEE
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representof this C ty to enter upon the above-mentioned
property ori pection purp es. SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign of Permittee D